What is AERD/Samter’s Triad?
Aspirin Exacerbated Respiratory Disease (AERD), also known as Samter’s Triad or Aspirin Sensitive Asthma, is a chronic medical condition that consists of asthma, recurrent sinus disease with nasal polyps, and a sensitivity to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs). Approximately 10% of all adults with asthma and 40% of patients with asthma and nasal polyps are sensitive to aspirin and NSAIDs.
What are the symptoms?
Patients with AERD/Samter’s Triad usually have asthma, nasal congestion, and nasal polyps, and often do not respond to conventional treatments. Many have experienced chronic sinus infections and can lose their sense of smell. The characteristic feature of AERD/Samter’s Triad is that patients develop reactions triggered by aspirin or other NSAIDs.
These reactions can include:
- Increased nasal congestion or stuffiness
- Eye watering or redness
- Cough, wheezing, or chest tightness
- Frontal headache or sensation of sinus pain
- Flushing and/or a rash
- Nausea and/or abdominal cramping
- General feeling of malaise, sometimes accompanied by dizziness
If you not do have asthma, nasal congestion and/or nasal polyps but experience reactions to aspirin or NSAIDs, click here and here to learn about the Brigham and Women’s Aspirin and NSAID Allergy Clinic. The Aspirin/NSAID Allergy new patient packet can be found here.
Eosinophilic asthma and nasal polyposis are hallmarks of aspirin-exacerbated respiratory disease (AERD), and IL-5 inhibition has been shown to provide therapeutic benefit. However, IL-5Rα is expressed on many cells in addition to eosinophils, and the mechanisms by which IL-5 inhibition leads to clinical benefit in eosinophilic asthma and nasal polyposis are unlikely to be due exclusively to antieosinophil effects.
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A series of patients with AERD who developed COVID-19, including many who were treated with respiratory biologics for their baseline AERD, did not appear to experience increased morbidity compared to the general population with COVID19. This is reassuring to those with exacerbation-prone asthma and nasal polyps. It is intriguing that a strong type 2 inflammatory signal in the respiratory tract — a signal that the vast majority of patients with AERD exhibit — might actually be protective against severe COVID-19. Read more here.
Drug challenge protocols for evaluation of non-AERD related NSAID hypersensitivity can vary widely by provider and institution and can be prohibitively time and resource intensive to perform. In this cohort of 249 individuals undergoing NSAID drug challenges, we describe the safety and outcomes of a 2-step NSAID drug challenge protocol. Over 85% of challenges were negative for an immediate or delayed reaction, allowing patients to use at least one clinically indicated NSAID. Challenge reactions were generally mild. These results indicate that a simple 2-step NSAID challenge protocol may be safely used in the outpatient setting to delabel appropriate candidates. Read here.
These studies use retrospective chart review to investigate the impact of having a reported allergy to aspirin or another NSAID on the outcomes of pain medication prescriptions, opioid prescriptions, and the subsequent risk of sustained opioid use or of developing opioid use disorder in populations of patients undergoing elective surgeries.